OBJECTIVES: 'Pierre Robin' is one of the most readily recognised eponyms in medicine, yet it is a poorly understood nonspecific grouping of malformations that has no prognostic significance. Previously known as 'Pierre Robin syndrome', the way this diagnostic entity is viewed is now undergoing change. It is the purpose of this paper to review previous thinking about Robin and provide an update on recent clinical observations. SOURCES OF DATA: A computerised literature search using MEDLINE, EMBASE, AJOL and OMIM was conducted for published articles up to March 2006. Mesh phrases used in the search were: Pierre Robin syndrome, Robin anomalad and Robin sequence (RS). RESULTS: This relatively uncommon association of micrognathia with cleft palate and upper airway obstruction which was initially thought to be a specific disease and entire treatment regimens established to deal with presumed problems is now understood to be a grouping of clinical findings that does not represent a distinct multiple anomaly syndrome. The condition is therefore now described as 'Pierre Robin sequence'. Evidence of distinct cytogenetic anomalies has also highlighted the aetiological heterogeneity associated with RS in recent times. CONCLUSION: Infants with Robin sequence can present with varied problems, some of them emergencies. Clinicians must be aware of the high prevalence of associated syndromes and the possible contribution of other syndromic features to the problems for proper patient care. Candidate loci and potential candidate genes are currently being proposed in the literature for RS.

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BACKGROUND: Urethral catheterisation is a procedure which is daily performed in clinical practice. Though, interns are expected to be proficient in this, the situation is always not so and complications have occurred due to inadequate knowledge of safe urethral catheterisation. AIMS AND OBJECTIVES: The study is intended to assess the knowledge and the practice of urethral catheterisation of prospective interns with a view of making suggestions for improvement in the teaching of this procedural skill to medical students and interns. METHODOLOGY: Questionnaires were administered to all prospective interns who had applied to do their compulsory one year internship in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The data were analysed using SPSS 11 statistical package. RESULTS: There were 96 respondents 65 (69.9%) of these were males. They graduated from 6 medical schools in Nigeria and 1 in the Sudan and they were aged between 23 and 36 years. They all had observed urethral catheterisation before while 92.5% have performed urethral catheterisation: 78.5 % under supervision and 14% under no supervision and 7 (7.5%) have not. Only 19.4% had good knowledge of the indications for urethral catheterisation and 53.9% had knowledge of appropriate list of materials for safe urethral catheterisation. Only 29.1% could describe well the steps of safe catheterisation and 31.2%.could list well the possible complications of catheterisation. Less than half had good knowledge of appropriate catheter sizes. CONCLUSION: Urethral catheterisation is yet to be well mastered by many newly qualified interns and improvement in the teaching of procedural skills in medical schools may likely improve the situation.

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BACKGROUND: Port Harcourt is a city with a high concentration of companies (Industries) using organo-phosphorus compounds with workers who have been exposed to these compounds for varying lengths of time. This study looks at the effects of exposure to these compounds on the health of these workers relative to the control group by measuring the plasma cholinesterase activity of the workers and the control group. METHODS: In this prospective study, 200 subjects were selected from the companies in Port Harcourt (40 from each of five companies using organo-phosphorus compounds) and 50 controls selected from the state secretariat complex. The subjects in each of the five companies were again subdivided into "directly exposed" and "non-exposed". Among the "exposed" a group of workers who had worked in the organo-phosphorous unit for more than four years (prolonged exposure) were sorted out. The popular kinetic colorimetric method using Butyrylthiocholine with liquid reagents was used for measuring plasma cholinesterase activity. RESULTS: Results obtained showed significant reduction in the plasma cholinesterase activity of subjects exposed to organo-phosphorous compounds (5466+/-948) when compared with the control group (8042+/-1011) P<0.05. This reduction was more marked in those subjects who had been exposed to organo-phosphorus compounds for more than 4 years (4614+/-532) P<0.05. There was no significant difference in the mean plasma cholinesterase activity between the "non-exposed" company workers (8133+/-1635) and the control (8042+/-1011) P>0.05. CONCLUSION: Exposure to organo-phosphorus compounds causes reduction in the plasma cholinesterase activity and this reduction is directly related to the duration of exposure.

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Our objective was to identify risk factors for failed labour induction. From January 2001 to December 2005, we conducted a retrospective case-control study in a Nigerian University Hospital. Cases were women who failed to deliver vaginally after labour induction, and therefore had caesarean section. Controls were patients who were similarly induced and achieved vaginal delivery. Univariate followed by Logistic regression analysis were performed. Failed induction occurred in 37.6%. Variables significantly and independently associated with failed induction were cervical effacement < 70% (adjusted odds ratio [OR] 5.12; 95% confidence interval [CI] 2.65-9.90), Bishop's score < 6 (OR 3.47; CI 1.75 - 6.85), nulliparity (OR 3.91; CI 1.92 - 7.99). Prolonged pregnancy independently reduced failure rate (OR 0.44: CI 0.24 - 0.81). These variables can help determine patients that will require early recourse to caesarean delivery in order to avoid prolonged induction-delivery interval.

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BACKGROUND: Female genital tract malignancies cause a significant number of deaths in the developing world. These deaths are however usually overshadowed by maternal deaths from obstetric causes. STUDY DESIGN AND SETTING: A retrospective study of all histologically confirmed female genital tract malignancies seen in the histopathology department of the University of Uyo Teaching Hospital between January 2000 and December 2004. RESULTS: Sixty five female genital tract malignancies were studied. Majority of patients were in the fifth to seventh decades of life. Carcinoma of the cervix was the commonest cancer seen (49.2%) followed by ovarian cancer (21.5%). Carcinoma of the vulva was the least common cancer seen (1.5%). Squamous cell carcinoma was the commonest histological variety. CONCLUSION: Female genital tract malignancies are major causes of morbidity and mortality in Nigeria. There is thus a need for public enlightenment to increase the awareness of risk factors and the provision of regular cervical cancer screening services which should be free to encourage utilisation.

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AIMS AND OBJECTIVES: Worldwide, Caesarean sections are commonly done under regional anaesthesia which offers numerous advantages over general anesthesia. However there are still indications for the use of general anaesthesia in obstetric practice. This includes emergent Caesarean sections. This study sought to determine the factors that inform the decision on the choice of anaesthesia for Caesarean section in a tertiary institution in Nigeria. PATIENTS AND METHODS: All patients scheduled for elective and emergency caesarean sections between January and December 2002 were prospectively studied. Study variables included age of mother, gestational age and parity. Urgency of surgery, indication for surgery, maternal pre-existing disease and the choice of anaesthetic technique were documented. Neonatal weight was recorded and outcome was assessed by Apgar score at 1 and 5 minutes, the presence of respiratory difficulties and the need for admission into the Neonatal unit. RESULTS: One hundred and ninety-six patients were studied. Elective surgery was performed for 17.3%, while 47.4% and 28.6% had urgent and emergency Caesarean sections respectively. Urgency of surgery was not documented in 6.7% of cases. Previous caesarean section was the commonest indication for elective procedures (47%), foetal distress for emergency (62.5%) and previous caesarean section in labour for urgent procedures (30.1%). General anaesthesia was employed in 33.2% of patients while regional anaesthesia was used in 66.8%. Fifty per cent of emergency cases had general anaesthesia. Regional anaesthesia was used in 72% of urgent and 85.3% of elective procedures. The commonest regional technique was spinal anaesthesia (60.7%). Nineteen per cent of our patients had a co-existing medical problem, and 73% of these received a spinal anaesthetic. More neonates delivered under general anaesthesia had respiratory difficulties at birth (p=0.002) and more were admitted to the Neonatal unit (p=0.031). CONCLUSION: The choice of anaesthesia depends on the urgency of surgery and the medical condition of the mother. General anaesthesia was more likely to be administered for bleeding emergencies and foetal distress. Spinal anaesthesia was preferred for elective and urgent cases or when maternal disease existed..

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INTRODUCTION: HIV is assuming an alarming pandemic worldwide and presently in Nigeria it is a source of concern to all and sundry. AIM: To review the demography of cases positive for HIV in the eye clinic over a 5-year period and to identify ocular diseases that have high predictive value for HIV. METHODS: A retrospective study of all the patients that were screened for HIV in the eye clinic over a 5-year period was done. Screening was by ELISA method with confirmation by Western blot test. RESULTS: A total of 60 patients were screened and 26 (43.3%) of them were HIV positive. The male to female ratio of HIV positive patients was 1:1. All the seropositive patients were between the ages of 20-49 years and about a third were students from the higher institutions. Half of the patients were single. Diagnoses with high predictive values were Herpes Zoster Ophthalmicus (62%), Steven Johnson syndrome (50%), HIV retinopathy (75%), Bilateral Unresolving Toxoplasmosis (42%). The common presentations however are Herpes Zoster Ophthalmicus (HZO) and unresolving bilateral Uveitis. CONCLUSION: HIV and ocular involvement is increasing in Ilorin. The high-risk groups among patients presenting to the hospital are students of higher institutions and Soldiers. Diseases of high predictive indices are Herpes zoster Ophthalmicus, Steven Johnson's syndrome, HIV retinopathy.

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Protein-energy malnutrition (PEM) is a major public health problem in the tropical and subtropical regions of the world and often arises during protein and / or energy deficit due to nutritional inadequacy, infections and poor socio-economic and environmental conditions. It is the most common nutritional disorder affecting children in developing countries and the third most common disease of childhood in such countries. PEM has a lasting effect on immune functions, growth and development of children, learning ability, social adjustment, work efficiency and productivity of labour. It seems that many deaths from PEM occur as a result of outdated clinical practices and that improving these practices reduces the rate of morbidity and mortality. This paper reviews various metabolic changes in protein-energy malnutrition (PEM). It gives an overview of the theoretical basis for the understanding of the biochemical derangements in PEM. It aims at stimulating the paediatricians and clinical chemists to read more on the recent advances in this broad subject with the view to improving the understanding of the current laboratory investigation of PEM. This review demonstrates that the metabolic changes in PEM include water and electrolytes imbalance, amino acids and proteins deficiencies, carbohydrates and energy deficiencies, hypolipidaemias, hypolipoproteinaemias, hormonal imbalance, deficiency of anti-oxidant vitamins and enzymes, depression of cell-mediated immune complexes and decrease in amino acids and trace elements in skin and hair. The review therefore suggests that assessment of these conditions in PEM patients could improve the management of this group of patients and hence reduce the rate of morbidity and mortality from PEM.

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OBJECTIVE: This review aims to highlight the significant developments in neuroscience and clinical neurology that have been recorded in the past few years. METHODS: Original research and reviews were identified by searching PubMed for articles published from January 1995 using the following search terms: recent, developments, advances, progress, neurology, and neuroscience. RESULTS: Notable strides have been made in the management of neurological conditions like stroke and epilepsy. There is also greater understanding of the pathogenesis of the neurodegenerative diseases, and some form of treatment is now available for previously 'untreatable' conditions like motor neuron disease and Alzheimer's disease. The application of the techniques of molecular genetics and molecular cell biology has advanced the understanding and diagnosis of several neurological disorders, such as Huntington's disease and myotonic dystrophy. Clinical neurology has also profited from the huge advances in structural and functional brain imaging that have taken place in recent years. Areas of current research include the potential use of stem cells to treat a wide variety of neurological disorders, and the use of nerve growth factors to promote regeneration of neurons in the central nervous system. CONCLUSION: Current advances in neurology and neuroscience hold the promise of new approaches to the understanding and management of neurological diseases.

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OBJECTIVE: To investigate the efficacy, tolerability and cost effectiveness of three antibiotics in a short-term antibiotic regimen in patients undergoing elective implant surgery. PATIENTS AND METHODS: 89 patients who underwent 101 implantation procedures were enrolled during a period of five years and randomly divided into three groups to receive: (a) Rocephin (Ceftriaxone) 1g intravenously at induction and 1g 12 hours later (Group 1). (b) Zinacef (Cefuroxime) 1.5 g intravenously at induction and 750 mg six hourly for 12 hours (Group 2). Ciprotab (ciprofloxacine) 400mg intravenously at induction and 200mg six hourly for 12 hours (group 3). RESULTS: The patients in the three groups were comparable regarding age, gender, pre-operative length of hospitalization and duration of surgery. The overall surgical site infection rate was 6.9% (7/101) with gram-negative organisms being the most common causative organisms (71.4%). The infection rates of 6.3% in group 1,7.3% in group 2 and 7.1% in group 3 show no statistical significance (P>0.05). The cost benefit ratio for the three drugs showed that treatment with Ciprotab was cheaper than that with Rocephin or Zinacef. Severe complications warranting discontinuation of therapy did not occur in any of the three groups of patients. CONCLUSION: While we can safely conclude that all the drugs have similar efficacy and safely in preventing post-operative wound complications, it appears that Ciprotab is most cost-effective. We recommend that a larger study be undertaken to confirm the predominance of gram-negative organisms in implant surgery.

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OBJECTIVE: To evaluate the causes, clinical features and treatment of traumatic tympanic membrane perforation in University of Port Harcourt Teaching Hospital. PATIENTS AND METHODS: Patients with traumatic perforation of the tympanic membrane from August 2003 to February 2005 were evaluated clinically to determine the cause and the site of perforation. They had pure tone audiometry done. Treated by non- surgical means and followed up. RESULTS: Fifty- eight (8.6%) patients with traumatic perforation were seen among 676 patients with aural diseases. Average age was 27.56 years. Causes of traumatic perforation were, fights with spouse 27.6%, street fights 19%, instrumentation 17.2% and state security agents 15.5%. Hearing loss 94.8%, tinnitus 84.5% and otalgia 67.2% were common complaints. 63.8% had perforation in the lower half of pars tensa. 42.4% had mild conductive hearing impairment. 29.3% healed within 3 weeks. CONCLUSION: Physical blow to the ear was the commonest cause of tympanic perforation.

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OBJECTIVE: To know the perspective of trainee Ophthalmologists on the present state of Ophthalmology training in Nigeria. MATERIALS AND METHODS: Semi structured questionnaires were administered on trainee ophthalmologists from 13 different training centres across Nigeria during revision courses and Fellowship examination in year 2004. Included were age, sex, training levels and number of year in training. Also assessed were information on acquisition of theoretical knowledge, surgical and managerial skills as well as availability of relevant ophthalmic resource materials and equipment in their training institutions. Suggestions on the ways to improve the training in Nigeria were also noted. RESULTS: There were 51 trainees with ages ranging from 29 to 51 years, with a mean of 34.65 (S.D+4.76) year. The male to female ratio was 1.6:1. There were 18 (36%) senior registrars, 31 (62%) registrars and 1 (2%) senior house officer. The period spent in training varied from 2 months to 10 years with a mean of. 3.6 years (S.D+2.2). Acquisition of theoretical knowledge was judged to be adequate by 48 (98%) of trainees. Also acquisition of surgical and managerial skills as well as availability of qualitative ophthalmic resource material were judged to be adequate by 35 (68.7%), 40 (81.6%) and 38 (74.5%) trainees respectively. Suggestions among others include improvement in quantity and quality of ophthalmic resource materials, high volume ophthalmic surgery to aid surgical skill acquisition and structured training programme. CONCLUSION: Ophthalmology training in Nigeria offers adequate theoretical knowledge and managerial skills acquisition. However, there is the need for further improvement in the area of surgical and diagnostic skills transfer and acquisition as well as availability of quality ophthalmic resources and a well-structured training programme in all the centres.

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OBJECTIVES: This study was designed to assess the prevalence of HBV and HCV infection in HIV patients and evaluate the risk of infection compared with HIV negative control subjects. METHOD: This is a prospective case control study in which 240 HIV/AIDS patients and age and sex matched controls were evaluated. The diagnosis of HIV infection was based on a positive HIV screening test using Capillus test kits (Trinity Biotech PLC, Ireland) and confirmed using Western blot assay. HBsAg and anti-HCV were assayed by commercially available chromatographic immunoassay (SD BIOLINE). RESULTS: Eleven (9.2%) of the 120 HIV/AIDS patients and 8 (7%) of the 120 control subjects were positive for the HBsAg (OR=1, p=0.27). HBeAg was detected in 3 of the 11 (27.3%) subjects with HIV/HBV co infections. HIV positive patients were 7 times more likely to have HCV infection than control patients (5.8% compared with 0.8%, OR=7.3, p= 0.03). CONCLUSION: The lack of a strong association between HBV and HIV infection may be related to different exposure routes in this population where HBV infection is highly endemic and childhood infection almost universal. In this African population, HIV infection may be a super-infection of HBV infections contracted in childhood. This high HCV/HIV co-infection rate is consistent with the shared parenteral and sexual routes of transmission.

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OBJECTIVE: To investigate the attitude of some Nigerian surgical residents to trauma care. SUBJECTS AND METHOD: Surgical residents from three tertiary care facilities located in South Western Nigeria completed a structured questionnaire, which contained twelve questions directed at eliciting their attitude to trauma care. RESULTS: Fifty-four residents completed the questionnaire. Majority of them were males (88.9%) and aged =30 years (96.3%). Over half (55.6%) were junior residents and one third each had stayed for <2 years, >2-4 years and >4 years respectively in training. Specialties represented included Oral and maxillofacial surgery, General surgery, Orthopaedic surgery, Ophthalmology, Otorhinolaryngology, Urology and Cardio thoracic unit. Only 9.3% and 13.0% of them had received training in the ACLS and ATLS respectively. However, most trainees displayed moderate (42.6%) to major (46.3%) interest in care of the injured judging by the time in future practice hoped to be dedicated to trauma care. Most trainees considered trauma care a rewarding, gratifying and essential aspect of all surgeons practice. At the same time, majority felt it is stressful, time consuming and disrupts a lot of routine activities. CONCLUSION: The studied group displayed a high level of interest in the care of the injured and willingness to devote quality time to this despite the fact that trauma care was considered stressful and time consuming. A need to review our training curriculum to ensure that ATLS and ACLS are incorporated early in the training was observed.

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OBJECTIVE: To determine the knowledge of malaria and its control methods among urban dwellers in Benin City, Edo State with a view to making recommendations on its prevention. METHODS: The study was of a cross-sectional descriptive type, using multi-stage sampling technique. Semi-structured questionnaires were researcher-administered and data analysed by means of the Computer Programme for Epidemiologic Research (CPER). RESULTS: The indices of the knowledge of malaria were generally high. 92.5% had correct knowledge about the symptoms, 98.0% its mode of transmission, all the respondents knew at least one method of its preventive measures and 87.0% knew about therapy with chloroquine and other drugs. There was however, poor knowledge of the new artemisinin-based combination therapy (10.6%) and the Roll Back Malaria Initiative (31.5%). In spite of the positive findings on the knowledge, the practice of preventive measures were poor with only 27.8% using door and window nettings, 0.8% using insecticide treated mosquito nets and 25.6% using insecticides. CONCLUSION: Despite the availability of extensive sources of health information, there is the need for appropriate health education to stimulate positive changes in both knowledge and practice of malaria control. In addition, the campaign to " Roll Back Malaria" requires intensification.

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OBJECTIVES: The present study was designed to investigate the suitability of the hooded rat in experimental hypertension studies and to investigate some mechanisms underlying the development of hypertension. METHODS: Hooded rats were randomly divided into 4 groups: control, Salt, L-NAME (N' -Nitro-L-Arginine Methyl Ester) and salt+L-NAME. Control rats received a normal rat chow. Hypertension was induced in the test groups by giving 8% salt and/or 100mg/kg/day L-NAME for 6 and/or 4 weeks respectively. Urine and serum samples were collected from the rats and analysed for their cation contents. The blood pressure of the rats was measured. RESULTS: The mean arterial pressure (mean +/- SEM; mm Hg) increased significantly in the test groups of rats (salt: 138.3+/-4.0; L-NAME: 165.7+/-6.0; salt+L-NAME: 133.35.2) when compared with control (88.42.7; P<0.05). Water consumption, urine volume and Na+ excretion increased significantly in salt-loaded and salt+L-NAME groups compared with control (P<0.05) but remained similar in L-NAME rats. These values were however significantly less in salt+L-NAME rats compared with salt loaded rats (P<0.05). Urinary K+ excretion, serum Na+ and K+ concentrations remained similar in all groups. CONCLUSIONS: These results suggest that the hooded rat may be useful for experimental hypertension studies. Attenuation of the diuretic and natriuretic responses to salt loading in the presence of L-NAME suggests that nitric oxide is involved in the mechanisms involved in these responses. It is concluded that nitric oxide deficiency may exacerbate salt and volume retention in salt-loaded rats and possibly play a role in the subtle renal defect underlying salt sensitive hypertension.

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OBJECTIVES: To evaluate the cases of sickle cell anaemia in obstetric practice, and to highlight their problems in pregnancy as well as their contribution to maternal and foetal outcome in Nigeria. We believe that the findings would be useful for designing interventions to reduce the obstetric burden of sickle cell disease. PATIENTS AND MATERIALS: The service delivery record of 42 pregnancies in 39 patients with sickle cell disease was retrospectively reviewed at the University of Benin Teaching Hospital (UBTH) between January 2000 and December 2004. RESULTS: The incidence of sickle cell disease in the study was 8.7/1000 deliveries. Nearly 62% of the patients were aged 25-34 years, while 76.2% were either nulliparous (Para O) or primiparous (Para 1). There was one grandmultipara (2.38%). Anaemia (95.25%), Malaria (33.33%), Bone pain crisis (23.81%), and pneumonia (19.05%) in that order of frequency were the most common complications of pregnancy. The perinatal mortality rate was 250 per 1000 births while the maternal mortality rate was 47.6 per 1000 pregnancies. At delivery, 20% of cases had caesarean section (5% elective and 15% emergency) and the instrumental interventions include 12.5% vacuum and 27.5% forceps respectively. CONCLUSION: Early booking, good antenatal care and supervised hospital delivery produced a better obstetric outcome.

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OBJECTIVE: This study was undertaken to determine the baseline pelvic parameters as assessed by computed tomographic (CT) pelvimetry in Nigerian women and to compare the pelvic parameters with those derived from other studies. DESIGN: The study was carried out in pregnant women at 36 weeks and above referred for routine CT-pelvimetry. SUBJECT: A total of 100 pregnant women at 36 weeks and above referred to the Radiology Department were prospectively recruited for this study, they included women with breech presentation after 36 weeks gestation and women who either had previous lower segment caesarean section for reasons other than confirmed or suspected cephalopelvic disproportion (CPD). The subjects' ages ranged from 24-45 years. RESULTS: The mean anteroposterior and transverse inlet pelvic diameters were 11.6 cm +/-SD 0.9 and 12.0 +/-SD 0.8 cm respectively. The range of anteroposterior and transverse diameters of the inlet were 8.4 cm-14.0 cm and 10-13.8 cm respectively. The mean outlet diameter was 11.5 cm +/-SD 1.2 cm. The mean bispinous diameter of the pelvis was 10.6 cm +/-SD 0.9 cm. There was significant positive correlation between anteroposterior diameter inlet and outlet as well as the bispinous diameters (1st, 4th - 6th pairs) p<0.001. CONCLUSION: here are significant variations in pelvic parameters of Nigerian women when compared with values from other countries of the world. These significant variations are anthropometric in origin.

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